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Acupuncture during IVF

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Should IVF patients have acupuncture? It turns out only some of them should.

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Acupuncture during IVF

  1. 1. Acupuncture and embryo transfer…..... Should IVF patients have acupuncture? Can it really influence the outcome?
  2. 2. Is the evidence in? This is the question our patients, and their specialists, often ask us. It’s a good question!
  3. 3. Or is the jury out? There is a lot to think about, and analyse …...
  4. 4. There are more than 20 trials published in medical journals For all the references and abstracts please see http://acupuncturepregnancy.com.au/research-reviews/
  5. 5. All of these clinical trials examine the effect of acupuncture on the outcome of embryo transfer (measured as implantation, clinical pregnancy, ongoing pregnancy or live birth)
  6. 6. Some trials did acupuncture on the day of transfer of day 3 embryos and some on the day of transfer of day 5 embryos
  7. 7. Some of the trials did acupuncture immediately before and immediately after the embryo transfer, some did acupuncture only after the transfer or at another time. Some trials did acupuncture in the IVF clinic, some did it in adjacent clinics or across town. Most of the trials used the same acupuncture points – but not all.
  8. 8. Most trials used traditional acupuncture needles, but some used laser ….
  9. 9. Some used electro-stimulation on acupuncture points
  10. 10. Some used sham needles in the control group …. These are to fool patients into thinking they are having real acupuncture, but the needles only prick and don’t actually penetrate the skin.
  11. 11. Some used “wrong acupuncture” points in the control group ie they used points that were not on an acupuncture meridian, or points not relevant to fertility treatment.
  12. 12. Some used “usual care” in the control group • ie they didn’t do anything different to what they would normally do in an IVF cycle
  13. 13. What did they find? • More than two thirds of these studies report a statistical benefit of having acupuncture during an IVF cycle ….....
  14. 14. The next step is to do a meta-analysis A Meta-analysis is a statistical technique for combining the findings from independent studies, and is used to assess the clinical effectiveness of healthcare interventions.
  15. 15. What did this find? Of 9 meta analyses examining acupuncture treatment of IVF patients, 2 found no effect at all, 7 found that acupuncture conferred an advantage in IVF outcomes (in some cases the advantage was significant only when chances of success were not high, or when usual care, rather than sham needling, was the control group).
  16. 16. Forest Plots • The most recent meta-analysis plotted comparisons of all the different trials www.ncbi.nlm.nih.gov/pmc/articles/PMC3395377
  17. 17. Forest Plot 1 When all the qualifying trials that examine the effect of acupuncture at time of embryo transfer (compared to all the different control types including sham needling) are plotted, we can see there is a trend to improved outcomes with acupuncture treatment. Zheng CH et al, doi:10.1155/2012/543924
  18. 18. Forest Plot 2 When the same sort of analysis compares trials of patients having acupuncture on day of embryo transfer with a control group who did not have “sham acupuncture”, the trend favouring acupuncture is even more obvious. Zheng CH et al, doi:10.1155/2012/543924
  19. 19. Forest Plot 3 And when we examine the pregnancy rate in the trials that did acupuncture during the whole IVF cycle (not just at embryo transfer) compared to usual care, the trend toward favouring acupuncture treatment is stronger again. Zheng CH et al, doi:10.1155/2012/543924
  20. 20. But back to the clinic; what is embryo transfer acupuncture? Embryo transfer acupuncture is usually two treatments, one applied before the transfer and one after. The acupuncture points chosen include those shown in clinical trials to have a beneficial effect on outcomes for some IVF patients
  21. 21. Before the transfer We use acupuncture points on the abdomen as well as points on the limbs, the head and the ear. Some of these will be those used in clinical trials, and some will be chosen according to pulses and symptoms.
  22. 22. After the transfer We use acupuncture points on the head, ear and limbs but not on the abdomen. As before, points are chosen according to pulses and symptoms as well as research trial protocols.
  23. 23. How does acupuncture increase IVF success rates? • Well, we don’t really know ….. • But we do have some clues .......
  24. 24. Here’s what we do know …..... • implantation of embryos is negatively affected by stress, and auto-immune factors • stress can reduce IVF success rates • fertility is compromised if stress hormones are elevated For all references; acupuncturepregnancy.com.au/preparing-to-conceive-stress-management
  25. 25. And also …..... • Acupuncture has been shown to improve certain T- cell and cytokine levels • and increase levels of endogenous opioids eg endorphins, encephalins and serotonin. • and reduce cortisol and adrenalin levels • And it makes you feel very relaxed. For all references; acupuncturepregnancy.com.au/preparing-to-conceive-stress-management
  26. 26. A relaxed uterus might help too….... Uterine contractions after embryo transfer appear to reduce implantation and pregnancy rates. Acupuncture settles the body and the mind, and while we don’t know if it reduces contractions, most women report feeling more comfort in the abdomen after treatment. Renato Fanchin et al, Human Reproduction vol.13 no.7 pp.1968–1974, 1998 Pregnancy rate vs uterine contractions per min
  27. 27. And coming back to TCM, “Warming the womb”…..... In traditional Chinese medicine texts infertility was sometimes referred to as a “cold womb”. What we aim to do with Chinese medicine treatment at this time (and later) is to encourage the flow of “Qi and Blood” to nourish the embryo.
  28. 28. Any conclusions? • The research and our own experience, tells us that acupuncture treatment during an IVF cycle can confer a benefit to women who’s chance of success with IVF is 30% or less - ie older women and those who have done previous failed IVF cycles.

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